HPV vaccine in limited supply here

A vaccine that has the potential to cut down on cases of cervical cancer could save lives, local health officials say.

The problem is -- Wayne County does not have enough to go around.

The vaccine has been released in limited supply, and is currently available only to Medicaid and uninsured patients.

In June 2006, the Advisory Committee on Immunization Practices approved the first vaccine developed to prevent cervical cancer and other diseases in females caused by certain types of genital human papillomavirus, or HPV. The vaccine, Gardasil, protects against four HPV types, which together cause 70 percent of cervical cancers and 90 percent of genital warts.

The Food and Drug Administration has since licensed this vaccine for use in girls and women ages 9-26 years old. It is given through a series of three shots over a six-month period.

Several states have considered mandatory HPV vaccinations. As of February, only Texas had successfully made such a ruling. Eighteen other states are still considering it.

The N.C. Senate has tentatively approved a bill requiring schools to provide information for parents and guardians on cervical cancer. It doesn't discuss whether girls must get the HPV vaccine, but is more to educate parents about the potential benefits and side effects of the vaccine.

There has also been public opposition to mandating the vaccine be given to pre-adolescent girls, suggesting it violates parental rights. Wayne County Health Director James Roosen said the mandate also gives parents the right to opt out.

The Health Department ordered 50 doses from the state and was given 30, according to Debbie Garner, a registered nurse who works in the immunization program there.

There are basically two programs through which such medications come, she explained -- VCF, or vaccines for children, and universal. VCF is a government program, through which patients have to meet certain criteria, such as Medicaid or being uninsured, while the universal offers a broader availability.

"If they have insurance, patients will have to go where they can purchase it," she said, but noted that she "can't see the state making it universal for awhile."

That could present a problem to patients seeking the vaccine from family physicians.

Dr. Dave Tayloe of Goldsboro Pediatrics has been very vocal about this topic. In his sixth year on the board of directors for the American Academy of Pediatrics, he is also assigned to the academy's immunization task force.

"The question is, do you want to immunize or just immunize those that can't afford it?" he asked. "We started work in 1986 to convince the General Assembly that the state should pay for all the vaccines in North Carolina."

In 1994, Tayloe said, then-Governor Jim Hunt put $16 million in his budget to pay for all vaccines. In 1994, North Carolina joined a number of states participating in the universal vaccine program. The state, which pays for all the vaccines for preschoolers, has become a leader in the country for its universal program.

The government does not buy all the vaccines, however, and most physicians are losing money on them, Tayloe said.

"When we get vaccines from the state, they don't cover any of our costs for storing the vaccine, our insurance, the participation into what's called the immunization registry -- explaining the vaccine to the parent, giving the federal vaccine statement and getting them to sign for it," he said. "The biggest problem you have got is if you give me the vaccines, you're not covering my costs."

If the financing problem were solved, the supply question would go away, Tayloe said. And for his part, he would "do whatever I could to keep vaccines in the offices."

The HPV vaccine just may be the one to help break the ice, he said. It has been proven to prevent 90 percent of cervical cancer in the female population, and "we'll start giving it like hotcakes to kids on Medicaid," he said.

"Then the question is, will our private patients ask for the vaccine to the point that they call their insurance companies and say Goldsboro Pediatrics would give the vaccine if you would cover it?

"But how long is it going to take? How long are we going to have a double standard?"

Cost per dose of HPV vaccine has been estimated at $120. With three doses in the series, that jumps to $360. Groups like the American Medical Association and the American Academy of Pediatrics are addressing the situation and Tayloe is optimistic that the state will be on the front lines.

"It's neat to be in a place like North Carolina where we'll probably solve it faster than any place else," he said. "North Carolina is always in the top 10 of all the states in childhood immunization rates."